Objective:To explore the current therapeutic status of rhythm control versus rate control in elderly patients with atrial fibrillation(AF)and the related factors that may influence treatment decisions.Methods:A retrospective study was conducted on AF patients aged ≥75 years old who were hospitalized in the Healthcare Department of Beijing Hospital from January 2010 to May 2020.The patients were grouped and compared according to whether they underwent rhythm control or rate control.Multivariate logistic regression analysis was used to investigate the factors that may influence the treatment decision of rhythm control or rate control.Results:A total of 167 patients was included, with a median age of 90 years old.Among them, 21 patients(12.6%)received rhythm control, and 109 patients(65.3%)received rate control.Compared with the group not receiving rhythm control, the rhythm control group had a younger age, higher BMI, higher diastolic blood pressure, a higher proportion of multiple medication use, a lower proportion of chronic kidney disease stage 3 or above, and higher hemoglobin levels(all P<0.05). Compared with the group not receiving rate control, the rate control group had a lower proportion of paroxysmal AF, a faster resting ventricular rate, a higher proportion of smoking history, a higher proportion of multiple medication use, coronary heart disease, pacemaker treatment, chronic obstructive pulmonary disease and/or asthma, and a lower proportion of cognitive impairment(all P<0.05). Multivariate logistic regression analysis revealed that multiple drug use( OR=11.578, 95% CI: 1.341-99.993, P=0.026)was positively associated with rhythm control therapy, while chronic kidney disease stage 3 or above( OR=0.248, 95% CI: 0.063-0.968, P=0.045)was negatively associated with rhythm control therapy.For rate control therapy, multiple drug use( OR=5.056, 95% CI: 2.253-11.347, P<0.001), resting ventricular rate( OR =1.033, 95% CI: 1.005-1.062, P=0.021), and chronic obstructive pulmonary disease(COPD)and/or asthma( OR=2.739, 95% CI: 1.124-6.672, P=0.027)showed positive associations. Conclusions:The application rate of rhythm control therapy is low in elderly AF patients, and ventricular rate control is the main treatment.Complex clinical conditions are the main constraints, and it is urgent to optimize individualized strategies based on prospective studies and develop new treatment techniques to improve clinical practice.

Objective:To investigate the significance of urinary 8-oxo-7, 8-dihydroguanosine(8-oxoGuo)in assessing the short-term prognosis of sepsis in frail elderly patients.Methods:We conducted a cross-sectional study involving 62 frail elderly patients diagnosed with sepsis who were admitted to the Emergency Intensive Care Unit(EICU)at Beijing Hospital between March 2021 and March 2022.Based on their 28-day prognosis, the patients were categorized into two groups: those who died and those who survived.Upon admission, we collected urine samples and clinical data from both groups.We employed isotope dilution high-performance liquid chromatography-mass spectrometry to measure the levels of the RNA oxidation marker 8-oxoGuo in the urine.Results:A total of 62 frail elderly patients[aged(85.1±6.3)years]diagnosed with sepsis were included in the study, comprising 36 patients in the 28-day mortality group and 26 patients in the survival group.Univariate analysis revealed that the survival group had significantly lower body temperature, blood calcitonin(PCT)levels, sequential organ failure assessment(SOFA)scores, and urinary 8-oxoGuo levels compared to the mortality group.Additionally, the survival group exhibited a higher mean arterial pressure(MAP)than the mortality group, with all differences reaching statistical significance(all P<0.05).Spearman correlation analysis indicated that urinary 8-oxoGuo levels were positively correlated with both PCT and SOFA scores in frail elderly sepsis patients( r=0.426, 0.768, both P<0.05).Furthermore, logistic regression analysis identified urinary 8-oxoGuo and SOFA as independent risk factors for 28-day mortality in this population( OR=1.936, 1.427; P=0.006, 0.002).The area under the receiver operating characteristic curve(AUC)for urinary 8-oxoGuo and SOFA in predicting the 28-day prognosis of frail elderly sepsis patients was 0.761 and 0.741, respectively, both demonstrating statistical significance(both P<0.001). Conclusions:Our findings suggest that urinary 8-oxoGuo possesses strong predictive value for the short-term prognosis of sepsis in this vulnerable population.

Objective To define the operation scale of the biochemical test project based on the risk model,and design the statistical quality control(SQC)strategy by rationally adjusting the risk factors.Methods The σ(σ)values for the biochemistry test items were calculated based on the imprecision(CV)of internal quality control(IQC),external quality assessment(EQA)offset bias(Bias)and allowable total error(TEa)of CLIA 2019.By evaluating and adjusting the patient risk factors,designed the SQC for multiple test biochemical items representing high σ,medium σ and low σ categories.Results Clinical biochemistry testing items with different QC levels showed different σ performance,with values for P and K quality control levels 2 higher than level 1 and the remaining items all had very similar.18 projects for risk σ≥4.96:CK,LDH,GGT,AMY,AST,MG,TG,TBIL,FE,NA,UA,CREA,P,ALP,K,ALT and CA,respectively.Controlled with a QC program 13s N=2,run size was 179～1 000 samples.ALB,GLU,CL,TP and UREA need to achieve the expected operational scale by adjusting for risk factors.Conclusion The laboratory can combine program testing performance and patient safety goals,design SQC strategies for clinical biochemistry testing programs by rationally adjusting risk factors,apply as few SQC procedures for as much testing as possible,and align the laboratory workload and reporting interval with the number of patient samples.

OBJECTIVE To observe the clinical efficacy of Xuefu Zhuyu Decoction(XFZY)in the prevention and treatment of radiation-induced lung fibrosis(RILF)in esophageal cancer patients with blood stasis type underwent concurrent chemoradiotherapy(CRT).METHODS A total of 130 esophageal cancer patients with blood stasis type who treated with concurrent CRT were randomly divided into an experimental group and a control group,with 65 cases in each group.No patients dropped out during the study period.Patients in both groups received CRT and standardized symptomatic treatment was given according to the condition if radiation-induced lung injury occurred during treatment.On the basis of the treatment of the control group,the patients in the experimental group received XFZY from the beginning day until 30 days after the completion of CRT.The TCM syndrome score of the two groups were compared before and after treatment.The incidence of acute radiation pneumonia(RP)and chronic RILF and changes in pulmo-nary function indicators[forced expiratory volume in the first second as a percentage of predicted value(FEV1%pred),forced vital ca-pacity(FVC),FVC as a percentage of predicted value(FVC%pred),FEV1/FVC ratio,and carbon monoxide diffusing capacity as a per-centage of predicted value(DLCO%pred)]and serum cytokine levels[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),hypoxia-inducible factor-1α(HIF-1α),vascular endothelial growth factor(VEGF),and transforming growth factor β1(TGF-β1)]were compared at 6 months and 12 months after the completion of CRT.The occurrence of adverse reaction during treatment was recorded.RESULTS The total score of TCM syndrome of the two groups was significantly improved and the experimental group was better than that of the control group(P<0.01)after treatment.The efficacy of TCM syndrome was better in the experimental group than that of the control group(P<0.01).There was no statistically significant difference in the incidence rate of acute RP between the two groups(P>0.05)at 6 months after the completion of CRT.The levels of lung function indicators FEV1%pred,FVC%pred,and DLCO%pred in the experimental group were higher than those in the control group(P<0.05),and the levels of various cytokines in the experimental group were lower than those in the control group(P<0.05).The incidence rate of chronic RILF in the experimental group was significantly lower than that of the control group(P<0.05)at 12 months after the completion of CRT.The DLCO%pred level in the experimental group was higher than that in the control group(P<0.01),and the levels of cytokines HIF-1α,VEGF,and TGF-β1 were lower than those in the control group(P<0.05,P<0.01).There was no serious adverse event observed in either group of patients during the treat-ment.CONCLUSION XFZY can effectively prevent and treat RILF in esophageal cancer patients with blood stasis type underwent CRT,reducing the loss to lung function caused by radiotherapy,and its mechanism may be related to downregulating the levels of cyto-kines of HIF-1α,VEGF,and TGF-β1.

Objective To define the operation scale of the biochemical test project based on the risk model,and design the statistical quality control(SQC)strategy by rationally adjusting the risk factors.Methods The σ(σ)values for the biochemistry test items were calculated based on the imprecision(CV)of internal quality control(IQC),external quality assessment(EQA)offset bias(Bias)and allowable total error(TEa)of CLIA 2019.By evaluating and adjusting the patient risk factors,designed the SQC for multiple test biochemical items representing high σ,medium σ and low σ categories.Results Clinical biochemistry testing items with different QC levels showed different σ performance,with values for P and K quality control levels 2 higher than level 1 and the remaining items all had very similar.18 projects for risk σ≥4.96:CK,LDH,GGT,AMY,AST,MG,TG,TBIL,FE,NA,UA,CREA,P,ALP,K,ALT and CA,respectively.Controlled with a QC program 13s N=2,run size was 179～1 000 samples.ALB,GLU,CL,TP and UREA need to achieve the expected operational scale by adjusting for risk factors.Conclusion The laboratory can combine program testing performance and patient safety goals,design SQC strategies for clinical biochemistry testing programs by rationally adjusting risk factors,apply as few SQC procedures for as much testing as possible,and align the laboratory workload and reporting interval with the number of patient samples.

OBJECTIVE To observe the clinical efficacy of Xuefu Zhuyu Decoction(XFZY)in the prevention and treatment of radiation-induced lung fibrosis(RILF)in esophageal cancer patients with blood stasis type underwent concurrent chemoradiotherapy(CRT).METHODS A total of 130 esophageal cancer patients with blood stasis type who treated with concurrent CRT were randomly divided into an experimental group and a control group,with 65 cases in each group.No patients dropped out during the study period.Patients in both groups received CRT and standardized symptomatic treatment was given according to the condition if radiation-induced lung injury occurred during treatment.On the basis of the treatment of the control group,the patients in the experimental group received XFZY from the beginning day until 30 days after the completion of CRT.The TCM syndrome score of the two groups were compared before and after treatment.The incidence of acute radiation pneumonia(RP)and chronic RILF and changes in pulmo-nary function indicators[forced expiratory volume in the first second as a percentage of predicted value(FEV1%pred),forced vital ca-pacity(FVC),FVC as a percentage of predicted value(FVC%pred),FEV1/FVC ratio,and carbon monoxide diffusing capacity as a per-centage of predicted value(DLCO%pred)]and serum cytokine levels[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),hypoxia-inducible factor-1α(HIF-1α),vascular endothelial growth factor(VEGF),and transforming growth factor β1(TGF-β1)]were compared at 6 months and 12 months after the completion of CRT.The occurrence of adverse reaction during treatment was recorded.RESULTS The total score of TCM syndrome of the two groups was significantly improved and the experimental group was better than that of the control group(P<0.01)after treatment.The efficacy of TCM syndrome was better in the experimental group than that of the control group(P<0.01).There was no statistically significant difference in the incidence rate of acute RP between the two groups(P>0.05)at 6 months after the completion of CRT.The levels of lung function indicators FEV1%pred,FVC%pred,and DLCO%pred in the experimental group were higher than those in the control group(P<0.05),and the levels of various cytokines in the experimental group were lower than those in the control group(P<0.05).The incidence rate of chronic RILF in the experimental group was significantly lower than that of the control group(P<0.05)at 12 months after the completion of CRT.The DLCO%pred level in the experimental group was higher than that in the control group(P<0.01),and the levels of cytokines HIF-1α,VEGF,and TGF-β1 were lower than those in the control group(P<0.05,P<0.01).There was no serious adverse event observed in either group of patients during the treat-ment.CONCLUSION XFZY can effectively prevent and treat RILF in esophageal cancer patients with blood stasis type underwent CRT,reducing the loss to lung function caused by radiotherapy,and its mechanism may be related to downregulating the levels of cyto-kines of HIF-1α,VEGF,and TGF-β1.

Objective:To explore the current therapeutic status of rhythm control versus rate control in elderly patients with atrial fibrillation(AF)and the related factors that may influence treatment decisions.Methods:A retrospective study was conducted on AF patients aged ≥75 years old who were hospitalized in the Healthcare Department of Beijing Hospital from January 2010 to May 2020.The patients were grouped and compared according to whether they underwent rhythm control or rate control.Multivariate logistic regression analysis was used to investigate the factors that may influence the treatment decision of rhythm control or rate control.Results:A total of 167 patients was included, with a median age of 90 years old.Among them, 21 patients(12.6%)received rhythm control, and 109 patients(65.3%)received rate control.Compared with the group not receiving rhythm control, the rhythm control group had a younger age, higher BMI, higher diastolic blood pressure, a higher proportion of multiple medication use, a lower proportion of chronic kidney disease stage 3 or above, and higher hemoglobin levels(all P<0.05). Compared with the group not receiving rate control, the rate control group had a lower proportion of paroxysmal AF, a faster resting ventricular rate, a higher proportion of smoking history, a higher proportion of multiple medication use, coronary heart disease, pacemaker treatment, chronic obstructive pulmonary disease and/or asthma, and a lower proportion of cognitive impairment(all P<0.05). Multivariate logistic regression analysis revealed that multiple drug use( OR=11.578, 95% CI: 1.341-99.993, P=0.026)was positively associated with rhythm control therapy, while chronic kidney disease stage 3 or above( OR=0.248, 95% CI: 0.063-0.968, P=0.045)was negatively associated with rhythm control therapy.For rate control therapy, multiple drug use( OR=5.056, 95% CI: 2.253-11.347, P<0.001), resting ventricular rate( OR =1.033, 95% CI: 1.005-1.062, P=0.021), and chronic obstructive pulmonary disease(COPD)and/or asthma( OR=2.739, 95% CI: 1.124-6.672, P=0.027)showed positive associations. Conclusions:The application rate of rhythm control therapy is low in elderly AF patients, and ventricular rate control is the main treatment.Complex clinical conditions are the main constraints, and it is urgent to optimize individualized strategies based on prospective studies and develop new treatment techniques to improve clinical practice.

Objective:To investigate the significance of urinary 8-oxo-7, 8-dihydroguanosine(8-oxoGuo)in assessing the short-term prognosis of sepsis in frail elderly patients.Methods:We conducted a cross-sectional study involving 62 frail elderly patients diagnosed with sepsis who were admitted to the Emergency Intensive Care Unit(EICU)at Beijing Hospital between March 2021 and March 2022.Based on their 28-day prognosis, the patients were categorized into two groups: those who died and those who survived.Upon admission, we collected urine samples and clinical data from both groups.We employed isotope dilution high-performance liquid chromatography-mass spectrometry to measure the levels of the RNA oxidation marker 8-oxoGuo in the urine.Results:A total of 62 frail elderly patients[aged(85.1±6.3)years]diagnosed with sepsis were included in the study, comprising 36 patients in the 28-day mortality group and 26 patients in the survival group.Univariate analysis revealed that the survival group had significantly lower body temperature, blood calcitonin(PCT)levels, sequential organ failure assessment(SOFA)scores, and urinary 8-oxoGuo levels compared to the mortality group.Additionally, the survival group exhibited a higher mean arterial pressure(MAP)than the mortality group, with all differences reaching statistical significance(all P<0.05).Spearman correlation analysis indicated that urinary 8-oxoGuo levels were positively correlated with both PCT and SOFA scores in frail elderly sepsis patients( r=0.426, 0.768, both P<0.05).Furthermore, logistic regression analysis identified urinary 8-oxoGuo and SOFA as independent risk factors for 28-day mortality in this population( OR=1.936, 1.427; P=0.006, 0.002).The area under the receiver operating characteristic curve(AUC)for urinary 8-oxoGuo and SOFA in predicting the 28-day prognosis of frail elderly sepsis patients was 0.761 and 0.741, respectively, both demonstrating statistical significance(both P<0.001). Conclusions:Our findings suggest that urinary 8-oxoGuo possesses strong predictive value for the short-term prognosis of sepsis in this vulnerable population.

Objective:to analyze the relationship between the changes of lymphocyte subsets and cardiac function classification in elderly patients with chronic heart failure and preserved ejection fraction.Methods:A total of 835 elderly patients with preserved ejection fraction treated in our hospital from August 2022 to June 2023 were retrospectively selected, and divided into grade Ⅰ(302 cases), grade Ⅱ(254 cases), grade Ⅲ(144 cases)and grade Ⅳ(135 cases)according to the cardiac function classification, and 211 cases in the same period were selected as the control group.The general data of patients were collected, and the expression of T lymphocyte subsets and serum levels of cardiac related factor in patients with different cardiac function classifications were compared and analyzed.Results:There were no statistically significant differences in age, gender, BMI, systolic blood pressure, diastolic blood pressure and heart rate between the two groups( P>0.05).The lower the cardiac function classification, the higher the levels of CD4 + [grade Ⅰ: (39.7±8.0)%, grade Ⅱ: (36.9±8.3)%, grade Ⅲ: (32.1±6.5)%, grade Ⅳ: (31.3±5.1)%], CD4 + /CD8 + [grade Ⅰ: (1.8±0.5), grade Ⅱ: (1.5±0.5), grade Ⅲ: (1.4±0.5), grade Ⅳ: (1.1±0.3)], and the lower the levels of CD8 + [grade Ⅰ: (23.9±5.1)%, grade Ⅱ: (25.5±8.4)%, grade Ⅲ: (26.3±10.0)%, grade Ⅳ: (30.7±9.0)%]in T lymphocyte subsets( F=56.846, 84.154, 23.965, P<0.05); the lower the levels of sST2, GAL-3 and GDF-15 in serum of patients with lower cardiac function classification( F=217.081, 141.741, 123.835, P<0.05); CD4 + and CD4 + /CD8 + were negatively correlated with cardiac function grading( r=-0.482 and r=-0.849, P<0.05), CD8 + was positively correlated with cardiac function grading( r=0.948, P<0.05); the effect of using T lymphocyte subsets to diagnose cardiac function grading was higher and the AUC was 0.984. Conclusions:The accuracy of lymphocyte subsets in the diagnosis of cardiac function grading in elderly patients with chronic heart failure and preserved ejection fraction is higher, which is worthy of promotion.

Objective To establish the analytical performance specifications(APS)for routine items of biochemical inspection based on the external quality assessment(EQA)and internal quality control(IQC)data.Methods The EQA data and IQC data of routine items of biochemistry inspection in clinical laboratory center of national health commission from 2021 to 2023 were collected from the Department Clinical Laboratory of Traditional Chinese Medicine Hospital of Chengdu Pidu District.Comparing the percentage difference of the EQA data and the IQC in control imprecision[expressed as the coefficient of variation(CV)]data with the 3-level evaluation criteria derived based on biological variation(BV),the percentage pass rate of EQA data and the pass rate of CV under control were calculated,so as to achieve the quality target of APS with 80％or more as the quality control product of this level as the routine biochemical test items of the laboratory.For the inspection items that did not reach BV standard APS or were not applicable to meet the standard,the APS would be set to the WS/T 403-2012 industry standard or based on current technical level.Results TEa/allowable CV of biochemical inspection items were as follows:Potassium(K)2.4％/1.9％,Sodium(Na)4.0％/0.9％,Chloride(Cl)4.0％/0.9％,Calcium(Ca)3.4％/1.8％,Phosphate(P)9.6％/1.9％,Magnesium(Mg)3.8％/2.0％,Glucose(Glu)6.1％/2.3％,Creatinine(Crea)3.9％/2.2％,Urea(Urea)8.6％/3.3％,Total protein(TP)4.9％/2.0％,Albumin(Alb)3.3％/1.9％,Total bilirubin(TBil)6.3％/2.4％,Alanine transaminase(ALT)9.3％/2.9％,Asparpartate transaminase(AST)6.2％/2.1％,γ-glutamyl transferase activity(GGT)9.2％/2.1％,Lactate dehydrogenase(LDH)6.8％/2.2％,Alkaline phosphatase(ALP)7.2％/3.3％,Total cholesterol(TC)of 8.3％/2.6％,Triglyceride(TG)12.9％/4.9％,Amylase(AMY)5.9％/1.6％,Creatine kinase(CK)4.3％/1.6％and Uric acid(UA)2.9％/1.0％.Conclusion The APS set based on BV or current technical level can be used as a quality target for routine laboratory clinical biochemistry testing programs,and the laboratory can select the suitable APS according to the actual situation.